Sub Rosas in Workers’ Comp

This article is for medical providers, insurance adjusters, and attorneys who want to better understand the process of a Sub Rosa within the context of a workers’ compensation case.

What is a Sub Rosa?

Sub Rosa is a fancy latin term that literally means “Under the Rose.” In workers’ compensation, however, it means secret investigation—surveillance. During a Sub Rosa investigation, usually an investigator is sent out to survey the injured worker. The investigator attempts to observe what level of physical activity the injured worker can or cannot perform. The second, and less common use of Sub Rosa in work comp is to investigate a doctor, an employer, work sites, and/or working conditions. 

What are the stakeholders looking for in a Sub Rosa?

When insurance adjusters, employers, or medical providers require a Sub Rosa investigation, they are normally looking evidence that an employee can perform observable physical activities that are in excess of what they claim they can do.

 For instance, an injured worker may report that they can’t lift anything, or can’t bend over, or can’t walk without a cane. The fundamental purpose of this surveillance is to verify or disprove the validity of what the person is claiming in regards to their physical or psychological conditions. 

Sometimes a patient may claim that they have good days and bad days. In these cases, their limitations ambiguous. It’s very important, therefore, that Sub Rosas span several, separate days, to provide an accurate view of the patient’s conditions.

What should the doctor do while viewing surveillance footage of a patient?

Most surveillance tapes are dead-boring. It is advisable for the doctor to dictate what she observes the patient doing while she watches the tape. It’s also important for the doctor to state whether she can clearly identify that the person being filmed is the patient in question, or whether she knows it is certainly not the patient, or whether she can’t tell.

When should an attorney consider requesting a Sub Rosa?

An attorney may consider a Sub Rosa to be useful if one or more of the following are present:

  • Is the patient off from work for a much longer time than is typical for their condition?
  • Does the patient have a history of workers’ comp cases where this has been a trend?
  • Do physical findings corroborate with the patient’s description of their symptoms?

Should a doctor confront the patient with apparent discrepancies before recommending a Sub Rosa?

Yes. There is a lot that can be gained from a frank discussion with the patient about their symptoms and physical findings. Here at RateFast, we are committed to remaining non-partisan—we believe the ultimate goal of a workers’ compensation claim should be to get patients safely back to work. Therefore, we recommend an open and honest discussion with the injured worker before considering surveillance.

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The Twisted Story of Asymmetric Spinal Motion and Your PR-4 Report

What is Asymmetric Spinal Motion?

Asymmetric means not symmetric, or unequal. Asymmetry of spinal motion means more movement in some directions than others.

A physical exam finding of asymmetric spinal motion is a gateway to a Diagnosis-Related Estimate (DRE) class II rating in the AMA Guides 5th Edition.

The AMA Guides 5th Edition in Chapter 15 The Spine on page 382 defines asymmetry of spinal motion as “Asymmetric motion of the spine in one of the three principle planes.”

But the AMA Guides goes to a little more effort here to help the medical examiner by stating: “To qualify as true asymmetric motion, the finding must be reproducible and consistent and the examiner must be convinced that the individual is cooperative and giving full effort.”

How to Document Asymmetric Spinal Motion in Your Report

When documenting asymmetry of spinal motion in an impairment report for rating purposes, it is helpful to the reader of your impairment report if you provide comments on muscle spasm, muscle guarding and employee cooperation. These comments also makes the observation more compelling.

When reading a report that includes the finding of asymmetry of spinal motion look for comments on muscle spasm, muscle guarding and employee cooperation.

California PR-4 Reports are about reproducible observations and findings. Reports that are minimally supported may be more confusing than helpful, and lead to costly delay for the medical examiner, the insurance administrator, and, of course, the injured worker and the employer.

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Muscle Guarding

Muscle guarding is simply the body trying to avoid a painful stimulus. When irritable muscles are touched, they don’t like it and try to pull away.

A physical exam finding of muscle guarding is a gateway to a Diagnosis-Related Estimate (DRE) class II rating in the AMA Guides 5th Edition.

The AMA Guides 5th Edition in Chapter 15, The Spine, on page 382 defines “Muscle Guarding” as “a contraction of of muscle to minimize motion or agitation of the injured or diseased tissue.” Don’t confuse this with muscle spasm, which is an “involuntary contraction of a muscle or group of muscles.”

Associated finding may include loss of the low back contour (lordosis) and may have “reproducible loss of spinal motion.”

If you’re writing a PR-4 report

When documenting muscle guarding in an impairment report for rating purposes, it is helpful to the reader if comments on lordosis and actual measured spinal motion are provided. These comments also makes the observation more compelling.

If you’re reading a PR-4 report

When reading a report which includes the finding of muscle spam look for comments on lordosis and evidence of loss of spinal range of motion.

California PR-4 Reports are about reproducible observations and findings. Reports that are minimally supported may be more confusing than helpful, and lead to costly delay.

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